Evidence map›Paper›PMID 39707127›Full record

GuidelineNeurocritical care2025

Guidelines for Seizure Prophylaxis in Patients Hospitalized with Nontraumatic Intracerebral Hemorrhage: A Clinical Practice Guideline for Health Care Professionals from the Neurocritical Care Society.

Jennifer A Frontera, Appaji Rayi, Eljim Tesoro, Emily J Gilmore, Emily L Johnson, DaiWai Olson, Jamie S Ullman, Yuhong Yuan, Sahar Zafar, Shaun Rowe

Abstract readSystematic ReviewPractice GuidelineMeta-Analysis
PubMed Publisher
In one paragraph

Guideline in Neurocritical care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

14 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Guideline
  2. Pooled it
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  4. Trial
  5. Article
  6. Article
  7. Article
  8. Review
  9. Observational
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Jennifer A FronteraDepartment of Neurology, New York University Grossman School of Medicine, 150 55th St., Brooklyn, New York, NY, 11220, USA. jennifer.frontera@nyulangone.org.ORCID 0000-0002-0719-2522
Appaji RayiDepartment of Neurology, Charleston Area Medical Center, Charleston, WV, USA.
Eljim TesoroDepartment of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.
Emily J GilmoreDepartment of Neurology, Yale School of Medicine, New Haven, CT, USA.
Emily L JohnsonDepartment of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
DaiWai OlsonDepartment of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Jamie S UllmanZucker School of Medicine at Hofstra/Northwell, Hempstead, New York, NY, USA.
Yuhong YuanDivision of Gastroenterology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
Sahar ZafarDepartment of Neurology, Harvard Medical School, Boston, MA, USA.
Shaun RoweDepartment of Clinical Pharmacology, University of Tennessee Health Science Center College of Pharmacy, Knoxville, TN, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThere is practice heterogeneity in the use, type, and duration of prophylactic antiseizure medications (ASM) in patients hospitalized with acute nontraumatic intracerebral hemorrhage (ICH).

methodsWe conducted a systematic review and meta-analysis assessing ASM primary prophylaxis in adults hospitalized with acute nontraumatic ICH. The following population, intervention, comparison, and outcome (PICO) questions were assessed: (1) Should ASM versus no ASM be used in patients with acute ICH with no history of clinical or electrographic seizures? (2) If an ASM is used, should levetiracetam (LEV) or phenytoin/fosphenytoin (PHT/fPHT) be preferentially used? and (3) If an ASM is used, should a long (> 7 days) versus short (≤ 7 days) duration of prophylaxis be used? The main outcomes assessed were early seizure (≤ 14 days), late seizures (> 14 days), adverse events, mortality, and functional and cognitive outcomes. We used Grading of Recommendations Assessment, Development, and Evaluation methodology to generate recommendations.

resultsThe initial literature search yielded 1,988 articles, and 15 formed the basis of the recommendations. PICO 1: although there was no significant impact of ASM on the outcomes of early or late seizure or mortality, meta-analyses demonstrated increased adverse events and higher relative risk of poor functional outcomes at 90 days with prophylactic ASM use. PICO 2: we did not detect any significant positive or negative effect of PHT/fPHT compared to LEV for early seizures or adverse events, although point estimates tended to favor LEV. PICO 3: based on one decision analysis, quality-adjusted life-years were increased with a shorter duration of ASM prophylaxis.

conclusionsWe suggest avoidance of prophylactic ASM in hospitalized adult patients with acute nontraumatic ICH (weak recommendation, very low quality of evidence). If used, we suggest LEV over PHT/fPHT (weak recommendation, very low quality of evidence) for a short duration (≤ 7 days; weak recommendation, very low quality of evidence).

Indexed as

AnticonvulsantsCerebral HemorrhageCritical CareSeizuresHumansLevetiracetamAnticonvulsantsLevetiracetamAntiepileptic medicationAntiseizure medicationDilantinEEGEpilepsyFosphenytoinGuidelineIntracerebral hemorrhageKeppraLevetiracetamOutcomePhenytoinPreventionProphylacticProphylaxisRecommendationSeizure

Identifiers

PMID39707127

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.